Hamstring flexibility : measurement, stretching and injury susceptibility

Abstract

ix Flexibility has traditionally been considered an important component of human physical fitness but this conjecture lacks supporting empirical evidence. While there is extensive published research examining the relative importance of flexibility and the impact of various methods of stretching on levels of flexibility, performance and injury risk, the quality of studies has varied considerably, reliability and validity of methodology has not always been proven, and rationale has at times been questionable. Additionally, much literature has focused on static flexibility which is not necessarily related to properties of the musculotendinous unit and thus dynamic flexibility. This thesis was designed to fill gaps in the existing literature by using accepted methods to establish relative and absolute reliability of hamstring flexibility tests, consider the comparability of static and dynamic components of the global concept of flexibility and explore how dynamic flexibility and performance are influenced by fatiguing exercise and subsequent static stretching. The first aim was realised by a repeated measures study designed to establish the intraday and interday, intrarater reliability and measurement error of static and dynamic measures of hamstring flexibility. Significant relative reliability for measures of static and dynamic hamstring flexibility was demonstrated via intraclass correlation coefficient (3,1) but limits of agreement analysis indicated there was a degree of absolute measurement error that must be interpreted in relation to analytical goals. The second aim required evaluation of relationships shared by static and dynamic measures of hamstring flexibility. Significant relationships between the different static flexibility tests were established but the extent of unexplained variance indicated that only measurements from the same tests should be directly compared to each other. Relationships between different measures of dynamic flexibility and static flexibility varied from non-significant to moderately strong, suggesting that measures of static and dynamic flexibility are not identical and results should not be interchanged between the two types of tests. Due to a lack of explanatory empirical evidence, the final chapter aimed via a prospective randomised repeated measures study to investigate the impact of fatigue and post-exercise static stretching on measures of dynamic flexibility and performance. Fatigue resulted in no significant changes to passive or active dynamic flexibility measures but a significant worsening of static flexibility levels and perceived stiffness. Post-exercise stretch resulted in significantly increased passive and active energy absorption immediately and 18 hours post-exercise and in significantly reduced joint position sense immediately post-exercise. Effect sizes were small so the clinical meaningfulness of performing post-exercise static stretching is questionable, particularly if performed in place of other, potentially more beneficial practices.